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How to Avoid Becoming a Cardiac Patient: A Guide for the Worried

Most patients who come to see Sarah Y. Fan, MD, a cardiologist at New Jersey Cardiology Associates in West Orange, and a member of Barnabas Health Medical Group, already have some form of coronary disease. But not all of them do.

“Some people come to see me as a preventative measure, either because they have a family history of coronary disease or they know they have certain risk factors,” Dr. Fan says. “They get to middle age and start to worry.”

In those cases, Dr. Fan takes a number of steps to assess the patient’s situation—and then either reassure him or her, or determine a course of treatment.

Review controllable risk factors.

“These modifiable factors include smoking, high cholesterol and high blood pressure,” Dr. Fan says. She also takes a patient’s age, weight and level of physical activity into account.

Review family background.

“We ask whether they have a family history of premature coronary disease. Did someone in their immediate family—siblings, parents, grandparents—have this in their 40s or 50s?” Dr. Fan says. While risk from heart disease does have an inherited component, it’s not an inevitable legacy—especially if a person follows a heart-healthy lifestyle. (See sidebar, below.)

Check calcium score.

If a patient’s risk factors are somewhat out of the normal range, or if he or she wants more information, a calcium score test—a low-level CT scan—may be done. “We’re not looking for the kind of calcium that you take in a supplement for healthy bones,” Dr. Fan explains. “This is a mechanism in which there’s calcification of coronary arteries due to plaque buildup.”

Is there chest or other pain?

“Very often, a patient comes in with chest pain and wants to know if it’s their heart,” Dr. Fan says. “In addition to looking at risk factors, I ask for specifics about the kind of pain.” For example, is it exertion related, meaning does it get worse with activity, and relieved at rest? This can indicate stable angina (chest pain caused by insufficient blood flow to the he art), which may indicate a blockage.

Some patients with heart issues may not have chest pain but may have associated symptoms, such as jaw ache, arm pain or nausea and sweating. Others describe not a pain, but a pressure in their chest.

Any of these situations may call for a stress test, in which a patient is connected to a monitor that measures heart rate, breathing, blood pressure and other indicators as a patient walks on a treadmill. Another possible test is an echocardiogram, in which ultrasound waves produce “pictures” of a heart’s valves and chambers. “There are various modalities of testing that can be done,” Dr. Fan says, “and it’s usually at the cardiologist’s discretion to see which is best for the individual patient.”

THE HEART-HEALTHY LIFESTYLE

To protect yourself against heart disease and stroke, make the following lifestyle changes recommended by the American Heart Association.

  • Eat healthy, with a diet high in nutrient-rich foods (vegetables, fruits, whole grains, low-fat proteins) and low in sweets, saturated fats and trans fats.
  • Be physically active every day. Three to four 40-minute sessions per week is a goal to shoot for, but start where you are—even if you can only do 10 minutes a day at first.
  • Lower high blood pressure by decreasing the amount of salt you ingest and taking medications as directed.
  • Stop smoking.
  • Limit alcohol. Maximum two drinks a day for men, one drink a day for women.
  • Reduce stress. Studies show it contributes to high blood pressure and may increase the risk of other forms of heart disease.

LOW-DOSE ASPIRIN—OR NO DOSE?

Low-dose aspirin is a staple of treatment for people who have had a serious heart attack or stroke. Daily low-dose aspirin has also become a health habit for many people with low or moderate risk of heart disease. However, several recent studies have reevaluated the risk/ benefit calculations for those groups. While regular aspirin use can help prevent blood clots, it can also lead to a higher risk of gastrointestinal bleeding. So, should you take it? “It’s a complex issue that depends on a patient’s condition and risk factors,” Dr. Fan says. “Don’t make any changes in your routine without consulting your doctor.”

WHAT’S YOUR 10-YEAR RISK?

Using an online calculator created by the American Heart Association and the American College of Cardiologists, you can assess your smoking, blood pressure and cholesterol factors as they relate to your 10-year risk for atherosclerotic cardiovascular disease (ASCVD). Visit www.cvriskcalculator.com.

Your heart doesn’t beat just for you. Get it checked. Learn more about the full range of cardiac services at Saint Barnabas Medical Center or schedule an appointment with one of New Jersey’s top cardiac specialists.